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It is my pleasure to welcome you on behalf of the executive committee of theSudanese Association of Paediatrician to 14th Scientific Conference and its so-cial events.

The Conference is a forum for reflecting scientific advances in paediatrics aswell as sharing local, regional and international experiences in the field. Wesalute and welcome our guests and colleagues from abroad.This conference is convened in a remarkable timing following the historic PeaceAgreement and the signing of the Constitution hopefully indicating a new erafor peace, development and prosperity. One theme ofthe conference is focusingon child health in the post-conflict era with a special focus on children in theSouth and other under-developed areas.A special tribute is deserved for paediatricians in the different states especiallythose working in the South, Darfur and other under-privileged states. Their res-olute and dedication to the cause of children in need is admirable.We hope the conference is going to reflect the inter-sectoral and inter-discipli-nary nature of the paediatric service with its promotive, preventive and curativeinputs and will reflect the research efforts of young paediatricians.Our thanks are due to all institutions and persons who supported the effort be-hind this event.We do appreciate your contributions and support.Finally, I would like to thank all members of the association for their contribu-tions to the activities of the association in the past two years.Once again welcome to this scientific and social occasion.

m~Ji(klll..Prof. Zein A. Karrar

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Prof. Salah A. Ibrahim

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Prof. Hafiz El ShazliProf. Ahmed Hamid AlabbadiProf. A/Rahman ElmuftiProf. Abd El Wahab El EidressyProf. Sayda BasharProf. Hassan Mohamed Ahmed AliDr. Sir Hashim A/SalamProf. Mabyou Mustafa A/WahabProf. Ali HabourDr. Yonis AlRahmanOr. Nur Elhoda AtallaDr. Haydar ElhadiDr. Atiat MustafaDr. lbrahim Gamar AldawlaDr. Kamal Mohamed KheirDr. Suad Eltigani AlmahiDr. Yahia ShakirDr. Layla Ali A/RahmanDr. Bakhita AtallaDr. Sirag Mohamed KheirDr. Babiker AlmubasharDr. Ali ArabiDr. Karem Eldeen MohamedDr. Walideen AlfakiDr. Ahmed ElfadilDr. Ahlam AlRahman

l.Prof. Mustafa Abdalla M. SalihProf of Paediatric NeurologyFaculty of MedicineKing Saudi UniversityRiyadh, KSA.

3. Prof. Waleed MorshidMEBS, FRCSConsultant NeurosurgeonFaculty of MedicineKing Saud University, Riyadh, KSA.

5. Dr. Osama H. ElshazaliMBBS, MRCPAConsultant Paediatric Cardiology,Freeman Hospital, Newcastle upon,Tyne, UK

7. Dr. Elsayed AIi,FRCPl, DCH, Dip Near (Lond)Consultant Paediatric NeurologistKing Fahad Military Complex,KSA.

9. Dr. Abdelazim M. Mobarouk,MBBs, MPCH, DLH, CABPSpecialist PaediatricianA lain, UA.E

1l.Haitham Elbashir,Consultant Paediatrician, GreatOrmana Street, Hospital & HovingeyPrimary Care Trust, London - UKEmail: haithamelbashir@hotmail.com

13.Alhadi Elmalik,DCH, MRCPCH,Consultant Paediatrician, UK

2. Dr. Taha AItahir TahaMBBS, Ph. D.John Hopkins UniversityBloomberg School and Public Health,Baltimore, MD, USAEmail: ttaha@ihsph-edu

4. Dr. Mohamed Zien Sid AhmedMBBS, MRCp, FRCPConsultant NeonatologistSecurity Force Hospital, Riyadh, KSA.

6. Satti A. SattiPaed. And Neonatology Dept.King Fahd Hospital,Abha, KSA.

8. Dr. Taha Sadig Ahmed,MBBs (Khau-) Ph.D. (Busiol, UK)Associate Professor,Collage of MedicineConsultant Clinical NeurophysiologyKing Saudi University, Riyadh , KSA.

10. Dr. Asaad T. Elabbas,MEBs, MMs, MRCP, DCHConsultant PaediatricianMayo General HospitalCastlebar, Ireland

12.Abdelmonem M. Hamid,MBBs, MRCPCH, UKConsultant Paediatrician,Kettering General Hospital,Kettering, UK

14. Prof. Momdouh Mahfouz,Pro! of Radiology, len Shams Univ.Cairo, Egypt.

Scientific Committee:

Pro!'. Zien Alabdeen Karrar (Chairman)Dr. Ibrahim E. Elaaela (Convernor)Prof. hafiz Shazali - MemberProf. Abdulwahab AlidreesyProf. Hassan Mohamed AhmedProf. Mabyo MustafaProf. Salah Ahmed Ibrahim"rof Abdulrahman Elmuftil"lrof. Mutawali HusseinProf. Ahmed Hamed AlabbadiProf. Gaafar Ibn AufProf. Ali HabbourOr. Yahia ShakirDr. Balla Awad EIseedOr. Omaima M. SabirDr. Elfatih AbuzidDr. Kamal M. KnionOr. Hassan Osman Omer (Member)Dr. Yahia Omer Hamza (Member)

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Liaison Committee

Prof. Salah Ahmed IbrahimDr. Walideen AlfakiProf. Sayda BasharDr. Atiat MustafaDr. Kamal Mohamed KheirDr. Bakhita AtallaDr. Sirag Mohamed KheirDr. Mohamed Osman MutwakilDr. Ali ArabiDr. Ahmed ElfadilDr. Muntasir TahaDr. Suad Eltigani AlmahiDr. Haydar ElhadiProf. Amna Mohamed SalihDr.Babiker AlmubasharDr. Khalid YousifDr. Nuha A/GhafarDr. Sara A/SalamDr. Amani GendilDr. Ibrahim A/Gader D

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Fund-Raising Committee

Or. Yonis (shagDr. Ali ArabiOr. Nur Elhoda AtallaDr. Ahmed ElfadilDr. Ahlam A/RahmanDr. Karem Eldeen MohamedDr. Ghada Sheikh EldeenDr. Maha Gad AllahDr. Mona BabikerDr. Mohamed BabikerDr. Amani GendilDr. Sara A/SalamDr. Elamin OsmanOr. A/Muneim AliDr. Amal A/BagiOr. EIshafie Eltaib Habib AllahDr. Abd Allah KhamisDr. Sulafa KhalidOr. Haydar El Hadi

DD 11

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Printing Materials Committee

Prof. Zein A. KarrarOr. Ali ArabiOr. Yasir Mahgoub MohammedMs. Huda Khalid AhmedMr. Mustafa Agabani, Design & Setting

DD

TuesdayJuly 26 th.200SRegional Hal

08:00 - 09:0009:00 - 10:3010:30 - II :00

RegistrationOpening session

Breakfast

II :00 - 12:05Africa Hall

First plenary session

Chairman: Dr. Ahmed Hassab El RasoulCo chairman Dr. Yahia Omer Hamza

: Prof. Sayda Bashar

11:00 - 11:30 Peripheral neuropathyProf. M. A. M. Salih

HydrocephalusOr. Waleed Murshed

DiscussionBreak

11:30 - 12:00

12:00 - 12:3012:30 - 12:45

12:45 - 02:05 Ist free communicationsession

Africa HallHaematology & Oncology

ChairmanCo chairman

: Dr. Elsir HashimDr. A/Muniem Banaga

12:45 - 0 I :00 Pattern of childhood can-cer, in Sudan

Dr. Huda Haroun01 :00 - 0 I: 15 Dyskeratosis congenita

case reportDr. A/Rahim Satti

01: 15 - 0 I :30 Audit of management ofsickle cell crises in

Children in a London HospitalDr. A/Moniem M. Hamid

01:30 - 01:45 Correlation betweenPlasma Level of

V.W.F and severity of Sickle CellDisease

01 :45 - 02 :05 Discussion12:45 - 02:05 2nd free communication

session

Khartoum HallNeurology

ChairmanCo chairman

Prof. Mustafa Abdella: Dr. Elkhair Khogal

12:45 - 0 I :00 Acute Flaccid Paralysis, inPort Sudan

Dr. Khalid Elkhair01 :00 - 0 I: IS Patterns of childhood Epi-

lepsy in theEastern Province of Saudi Arabia

Dr. EI-Sayed Ali01: 15 - 0 I :30 The Importance of EEG

PaediatricansOr. Taha Sadig Taha

01 :30 - 01 :45 Neural Tube DefectsDr. Ghada Eltahir

01 :45 - 02:05 Discussion

12:45 - 02:05 3rd free communicationsession

Omdurman HallNeurition & DM

ChairmanCo chairman

Prof. Mustafa Abdella: Dr. Elkhair Khogal

12:45 - 01:00 Hospital treatment ofProt-ien Emergency

Mlanutrition Using Gerira FormulaProf. Hassan M. Ahmed

01 :00 - 0 I: 15 Weight Gain and Survivalof (SAM) Treated

with IM Ceftriaxone Vs. AmoxicillinProf. Salah A. Ibrahim

01: 15 - 01:30 Diabetes Mellitus, ketonbodies in DKA

Dr. Samar Abu Samra01:30 - 01:45 The Role of the Paediatric

DiabetesSpecialist Nurse

Dr. Assad T. Elabbas01:45 - 02:05 Discussion

:Prof Gaffar Ibn Ouf:Dr. Prof. Mut-wali AlMaged,

Dr. Suad Eltigani08:30 - 09:00 Advanced Paediatric Live

Support (APLS), Dr. Raif Higazi09:00 - 09:30 The Ethics of pr act icing

PaediatricProf. A.T.H.Eldrissy

Clinical Govemce ModelDr. Hadi Almalik

Neoroirnaging of CerebralMalformation

Prof. Mamdoh MahfouzDiscussion

Breakfast

WednesdayJuly 27th.200S

08:30 - 11:00

Africa Hall

ChairmanCo chairman

09:30 - 10:00

10:00 - 10:30

10:30 - 11:0011:00 - 11:30

Second Plenary Session

11:30 - 01:50 4th Free CommunicationSession

Africa HallNeonatology

ChairmanCo chairman

11:30 - 11:45

11:45 - 12:00

12:00-12:15

12:15 - 12:30

12:30-12:5012:50 - 01 :05

: Prof Essa ElaminOr. Fawzy A/Rahim, Dr.

Huda Haroun

CPAPDr.Mohamed Zien

Management of Babies ofHepatitis C Mothers

Or. AbushukMorbidity and Mortality in

MygomaDr. Yara Badereldin

IVF babiesOr. Zeinab Mohamed Gaily

OiscursionBreak

Africa HallNeonatology

ChairmanCo chairman

01:05 - 01:20

01 :20 - 01 :35

01 :35 - 01 :50

01 :50 - 02:05

02:05 - 02:25

11:30 - 02:25

Khartoum Hallcardiology

ChairmanCo chairman

11:30 - 11:45

11:45 - 12:00

12:00-12:15

12:15-12:30

12:30-12:45

12:45 - 01:0501 :05 - 01:20

AlRahim Mohamed ZeinDr. Mohamed Osman

Mutwakil,Dr. Khalid Elkhair

Neonatal IMCIProf. Salah Ibrahim

Phototherapy blue V whiteLight

Or. Abu Obaida BalaNeonatal Gall Bladder

Stone, Case ReportDr. Ibrahirn G. Eldawla

Infant FeedingDr. Maha Gadallah

Discussion

5th free communicationsession

: Dr. ElmuftiDr. Yahia Shaker, Or. Ali

Arabi

Pattern of Cardiac Diseasein Sudan Heart Center

Or. Sulafa KM. AIiGuide lines of Echocardiol-

ogyDr. Elfatih Abozied

Echocardiographic findingsin Sudanese children

at Ahmed Gasim HospitalOr. Siham A. H. El-RasoulBalloon Valvuloplasty for

Critical Neonatal AorticStenosis: Initial Results& Long-term Follow up

Dr. Osama Hafiz ElshazalyPattern of valvular in

volvement in RHODr. Samia Hassan

DisscusionBreak

Khartoum HallCommunity Paediatric

Chairman

Co chairman

01:20 - 01 :35

01 :35 - 01:50

01 :50 - 02:05

02:05 - 02:25

11:30 - 02:25

Prof. Hassan MohamedAhmed

Dr. Kamal MohamedKhair, Dr. Hydar Elhadi

Street Children, Health andSocial Aspects

Or. Abdel Latif IbrahimReformatories ChildrenMedical and Social Aspects

Dr. Sanaa K. MukhtarPrevalence Intestinal Para-sites in Jabal Awlia Area

Or. Amira EltaibDiscussion

6th free communicationsession

Omdurman HallTropici & Infection Disease

ChairmanCo chairman

11:30 - 11:45

11:45 - 12:00

12:00 - 12: 15

12:15 - 12:30

12:30 - 12:45

12:45 - 01:0501 :05 - 01 :20

: Prof. Ali HabourDr. Mahgoub M. Adarn,

Or. Hytham Elsaid

Paediatric TB Diagnosis &Treatment (U.K)

Dr. Hytham BashirTB Diagnosis and treat-

ment (Sudan)Dr. Muawia

Dengue FeverOr. Amal Malik

Vertical Transmission ofHepatitis B VirusDr. Hatim Gendil

Infection Caused by HiBOr. Karim Eldin M. Ali

DiscussionBreak

Omdurman HallTropici & Infection Disease

ChairmanCo chairman

: Dr. Atiat MustafaDr. Surag Mohamed

01 :20 - 0 I :35 Pattern of Sever Malaria inSudanese

Dr. Zeidan A. Zeidan01 :35 - 01:50 Neonatal Out come of

sever Malaria with pregnancyOr. AtifB. Fazary

01: 50 - 02 :05 Mothers Perception,Knowledge and

Practices regarding Childhood MalariaOr. Mubark A. Mohamed.

02:05 - 02:30 Discussion

ThursdayJuly 28th .2005

Africa Hall08:30 -10:30 Third plenary session

ChairmanCo chairman

: Prof. Hafiz Elshazali: Dr. Elhadi Elmalik,Dr. Bakheta Ataalla

HIV + Breast. FeedingDr. Taha Eltahir Taha

09:00 - 09:30 Expectrum of improvementof child health in southern Sudan

Dr. TongChild Health policy in

southern SudanFedreal Ministry of Health

Dr. Eltaib A. SaidDiscussionBreakfast

08:30 - 09:00

09:30 - 10:00

10:00 - 10:3010:30 - 11:00

11:00 -12:35 7th free communicationsession

Africa HallCardiac & Renal Session

ChairmanCo chairman

: Prof EledressyDr. Younis , Dr. Elfatih

11:00 - 11: 15 Clinical indicators ofserving of Sickle Cell Anaemia

Dr. Nagwa Elhassan11:15 - 11:30 Cardiac Lesion in Sickle

Cell AnaemiaDr. Ghada Osman

1I :30 - 11:45 Cardiac Disease in ChronicRenal Failure

Or. Tamadur Elnur11:45 - 12:00 Outcome of Treatment of

Nephrotic SyndromeDr. Mriam Beliel

12:00-12:15

12:15 - 12:35Or. Mohamed Elamin

Discussion

11:00 - 12:30 8th free communicationseSSIOn

KHartoum HallSouth SessionChairmanCo chairman

Prof. Z. A. Karrar: Dr. Rose Ajak

II:00 - 11:I0 Child Health indicatorsProf. Z. A. Karrar

11:10 - 1I :25 Child Health in the South,Previous Experience and Future Prospects

Prof. Mabyou M. AJ Wahb11:25 - 11:40 Child Human Security in

Post-Conflict SudanDr. Hassan El Obied

11:40 - 11:55 Post War PsychologicalTrauma to Children

Or. AJ Basit Merghani11:55-12:10

Dr. _12:10 - 12:30 Discussion

11:00 - 12:35 9th free communicationseSSIOn

Omdurman HallMiscellaneous Session

ChairmanCo chairman

Prof Salah Ibrahim: Dr. Nour Elamin

Osman, Dr. Bala Elsharief

11:00 - 11: 15 Evaluation of MedicalSchools in Sudan,Juba University

Dr. Walyeldin El-Nour El-Fakey11:15 - I \:30 Enuresis Clinic

Or. AJ Azim Mohd Mabrouk11:30 - 11:45 Experience of Young

Doctors in UKDr. Randa Eltegani

11:45 - 12:00 Nurse Role in ReducingMorbidity and Mortality

Sister Batoul12:00 - 12:15

Or. _12:15 - 12:35 Discussion

Peripheral Neuropathies in Children

Prof. M. A. M. Salih

The paper provides an update on acute and chronic forms of peripheral neuropathiesin children. Acute forms result in acute flaccial paralysis and include neuropathiesof infectious diseases such as diphtheria, brucellosis and neuroborreliosis. They alsoinclude acute toxic neuropathies due to heavy metals (lead and mercury) and organo-phosphates. Following success in controlling immunizable diseases in childhood, theimmune-mediated neuropathy, Guillain-Barre syndrome, is gaining significant impor-tance. The review will highlight the subtypes of Guillaine Barre syndrome (includ-ing Miller Fisher syndrome), their pathogenesis and recommended protocols for theirmanagement.

Chronic forms, on the other hand, encompass the inherited diseases of the peripheralnerves. Of these, the autosomal recessive (AR) types of Charcot-Marie-Tooth (CMT)are relatively more prevalent in North Africa and the Arabian Peninsula because ofthe high rate of consanguinity. This contrasts with the mainly dominant forms seenin Europe and the US. Two major phenotypes have been distinguished, in which theneuropathy is either demyelinating (CMTl) or axonal (CMT2). Several new entitieswere described in highly inbred Saudi Arabian and North African countries. Currently,more than 9 loci and 6 genes have been identified.In a collaborative research, we described the first identified gene causing an AR type ofCMT. The gene (Myotubularin-related 2 gene, MTMR2) and its mutations that lead toan AR severe demyelinating neuropathy, was identified in one Italian kindred and twoSaudi Arabian families. This gene, located on chromosome 11q22, was found to en-code the myotubularin related protein2. Further studies on the Saudi and Italian fami-lies revealed that MTMR2 interacts with neurofilament light chain protein (NF-L), thedeficiency of which causes another axonal form of CMT (CMT2E). The data furthersupported the notion that hereditary demyelinating and axonal neuropathies may repre-sent differential clinical manifestations of a common pathological mechanism.

Other phenotypically novel myelinopathies, axonopathies and other complex forms ofCMT that have been described in North African and Saudi Arabian populations awaitto have their genetic loci unravelled. In another joint study, we described a new genethat causes spinocerebellar ataxia associated with axonal neuropathy (SCAN 1). Thegene, Tyrosyl-DNA phosphodiesterase 1 (TDP 1) may cause SCAN I either by interfer-ing with DNA transcription or by inducing apoptosis in postmitolic neurons.

Child Human SecurityIn post conflict Sudan

By: Dr. Hussein Elobeid.helobeid@hotmaiI.com

Nation coming of along standing intrastate conflict experience a shift in perspectivefrom state to individual human security and Sudan is a classical example. The GoSand SPLM/A have identified, through the JAM process, the human security elementsof landmines action, DDR, IDPs reintegration and SSR as the corner-stone for peacebuilding, However, landmines, firearms and unaccopmaniedness are considered as themajor child human security threats. Almost all the battlefields of the civil war (TheSouth,NM,BN and Kassala) have witnessed indiscriminate use of landmines. Land-mines will continue to maim and kill (20 - 50% mortality rate) humans, particularlycivilian population (92% of the victims in Kassala state were civilians). Landlinesdenied access to health facilities in Kassala state (9% of hospitals, 5% of health centresand 3% of the dispensaries). The food security was severely affected in Kassala stateand consequently impacted the health and nutrition, particularly that of women andchildren. Availability and use of SALW create insecurity, encourage crime, freeze com-munity development and deny the future generation (children) their right for survivaland development. The redundancy of 100,000 child solders and availability of SALWconstitute a major security hazard and exacerbate childhood vulnerability. Physicaland psychological trauma, spread of infectious diseases including HIV IAIDS and childdestitute in general impose extra health burdens. Unaccompanied minors released fromthe war hostage back to the communities a pause daunting challenger for action.Child health professionals are at cross-roads to decide on how to react to child healthchallenges for post conflict Sudan, at the broader political landscape, whereby contrib-uting to durable peace building of the nation.

An Update on Childhood Neuromuscular Disorders

Mustafa A.M. SalihProfessor; Division of Paediatric Neurology. Department of Paediatrics. College of Medicine,King Saud University, Riyadh, Saudi Arabia

The paper highlights the epidemiologic, clinical and genetic profile of neuromusculardisorders in childhood and the contribution of research from the Region to the identi-fication of new entities and unravelling of the molecular pathologic features of these

diseases. This is expected to help in prevention through informed genetic counsellingand in designing new modalities of therapy.

With regards to diseases of muscle, it has been established that the integrity of thecytoskeletal-extracellular linkage, mediated by the dystrophin glycoprotein complex(DGC), is important to the muscle membrane stability, and loss or abnormality of cer-tain components lead to a disruption of this linkage and cause various forms of MD. Sofar, at least seven different MDs are related to abnormalities of the DGC.

"Adhalin", derived from the Arabic word "Adhal" for muscle, is one of the DGC whichhas recently been implicated in the pathogenesis of severe childhood autosomal reces-sive muscular dystrophy (SCARMD). During the last two decades, (SCARMD) wasidentified as a unique form of MD with high prevalence in populations of Arab descentin Africa and the Middle East. Over the decade 1982-1993, it was found to be com-moner (30%) than Duchenne MD (25°/.)) and similar to congenital MD (30%) at KingKhalid University Hospital (KKUH) in Riyadh.

The paper reviews the clinical and molecular pathological features of SCARMD seenin Sudan and Saudi Arabia; a newly described form of MD associated with deficiencyof a component of the DGC ( -dystroglycan); and a novel mutation in a Saudi familywith congenital MD due to partial deficiency of another component of the DGC (i.e.merosin or LAMA2). A fifth new variant or congenital MD characterized by arthro-gryposis multiplex, cobblestone lissencephaly and merosin (LAMA2)-positive immu-nohistochemistry will also be described, as well as, a sixth novel form (Salih, CMD).The latter was first described in a Sudanese family and is characterized by congenitalhypotonia associated with minimal myopathic changes and type-I fibre predominanceon muscle histology. Following achievement of motor developmental milestones, af-fected patients started to show progressive weakness associated with features of leftventricular dilated cardiomyopathy. Repeated muscle biopsies revealed florid dys-trophic features with normal expression of the DGC, including merosin (LAMA2).Integrin 7 and -dystroglycan (which has been discovered recently to be deficientin sub-groups of patients who present with congenital MD) were normally expressedin these patients.

Mothers' Perception, Knowledge and Practices regardingChildhood Malaria in SudanMubarak AI Rahman Mohamed, MBBS tu. of K.)Professor Zein Alabdin A. Karrar

This is a descriptive, cross-sectional, community-based study conducted between Janu-ary-June 2004. Five areas representing the endemicity categories in Sudan were se-lected. They were Khartoum (urban malaria), Shandi (hypo endemic), Gedarif(seasonalmalaria), Kenana (irrigated malaria) and Wau (Perennial high transmission malaria).

655 mothers of under 5 children were chosen through a multi stage random sampling;200 of them at health facilities accompanying their febrile children, who were exam-ined & a BFFM was taken for them and 455 mothers at household level.

330 (50.4%) of mothers, reported fever in last two weeks, 180(55.6%) of these weredue to malaria. However, the reported incidence of malaria during the survey time wasonly 11(5.5%).The perceived causes of fever were malaria in 396(62.8%), pneumonia 286(43.3%)& measles 92(14.6%). Convulsions as a risk of high fever was mentioned by 373(57.9%). Educated mother were significantly had better knowledge about fever causesand risk factors than illiterates.

The causes of malaria as perceived by mothers include: mosquito 558(86.3%) ex-haustion, dirt, bad food & blood transfusion. Fever and vomiting were the common-est symptoms of malaria mentioned by 532(82%) & 380(58.6%) respectively; whilecough was the least 47(7.2%).More than 254 (40%) mothers think that severe malaria presents with convulsions,wnle only 25 (3.9%) mentioned jaundice and/or pallor. Education significantly affectskoowledge of danger signs, but ages of the mothers significant only in not able to drinkor breast -feed.

595 (93.4%) mothers thought that BFFM was important, but 366 (56.4%) believed thatartipyretics given at home will affect the result.4E5(74.7%) of mothers sought help at a HF for childhood fever, 276(42.5%) gavehone-treatment and 52(8%) visited traditional healers. For malaria 608(93.7%) visiteda :-IF,26 (4%) gave home treatment and only 28(4.3%) went to traditional healers;hcwever, only 13(6.6%) visited HF within 24 hrs of fever.Fa convulsion, 355(55.8%) would visit HF & only 22(3.2%) mentioned traditionalhealers. Home-treatment of fever included cool bath in 327(57.8%), paracetamol in122(21.6%) and home remedies in 62( 11%). Traditional treatment of malaria includeduse of Aradaib (Tamarindus indica), Neem, Bee stings & others. Chloroquine was theco:nmonest antimalarial mentioned by 597(93.7%) and artemether was the least re-pcrted by 54(8.5%). Correct chloroquine dose was given by 67(72%) & two thirds ofmothers preferred oral drugs.

Bed nets as prevention method was mentioned by 524(80.8%), but only 214(59.3%)were using bed nets.The direct cost of malaria treatment ranged from 0.19 to 76.6 US$ with an average 4.7us $; and the media was the main source of information about malaria to 196 (33.4%)of mothers, health worker to 143(24.4%) and 225(38.3%) had only their own experi-ence. Education and age of the mother affects their knowledge & practices towardsfebrile children especially in treatment seeking, using tepid spongies at home and goodknowledge about malaria prevention. Implementing IMCI strategy & reducing the costof treatment for under 5 years children are important in improving health seeking be-haviour and then malaria control.

The Ethics of Practicing PaediatricsA.T.H. Elidrissy

The duty of physician practicing paediatrics is to care for a sick child with the aim ofpreventing mortality and reducing morbidity. To achieve this it is vital to prevent tlekilling 6 diseases . The cost of providing curative and preventive measures is the e-sponsibility of the government and it is a priority tm medical personnel. Islam staredthe support of children's life and health. The first person to do this was the secoidKhalifa Syidna Omer IBN Al Khattab who was giving subsidiary to prevent malnuti-tion to every child after being weaned, but on noticing that mothers were resolving toearly weaning (i.e. before completing 2 years), he ordered subsistence for every chldborn in the Islamic governments from Iraq to Egypt .Accordingly health of childenis the responsibility of the Islamic government .Parents specially in the poor secorof the community can not afford to pay for cost of curative paediatrics. We paediari-cians, and definitely everybody else, strongly believe that children are born to li-e.Accordingly, any childhood disease is an emergency and comes under the PresidentOmer AI-Bashir's ruling for Free Emergency Services to everybody. Any sick chldshould benefit from this presidential statement and treated free of charge in any snteor national government curative institute.

The physicians working in paediatrics also should follow the code of ethics of practcewhich is in line with all religions. In Islam, Ibn Alqa'im Aljouzia has put the 20 con-mands of ethical practice which should be followed by every physician.Our aim is a healthy children community to have a healthy future based on devotim,justice and mercy.

An Open Randomized Clinical Trial to Compare Weight Gainand Survival in Acutely Malnourished Children Treated with aTwo-day Intramuscular Ceftriaxone Regimen Versus StandardOral Amoxicillin

1- Vincent Brown2- Christine Dubray3- Salah Ahmed Ibrahim4- Mohammed A/Muttalib

1- Director, Epicentre - MSF, Paris2- Clinical trial researcher, MSF, Khartoum3 Department of Child Health, Faculty of Medicine, U of K

Severe acute malnutrition (SAM) has long time been recognized as a major publichealth issue. The association between infection and SAM has been largely document-ed. To lower deaths associated with infection, systematic broad-spectrum antibiotichas been recommended for the management of SAM However the appropriate anti-biotic regimen which is effective, of low cost and «easy-to-use» especially under fieldconditions has not been determined.The objective of this open randomized controlled clinical trial was to compare the ef-~ctiveness of a 2-day intramuscular ceftriaxone regimen (75 mg/kg/day), with a 5-dayoral amoxicillin regimen (80 mg/kg/day).

Children aged 6 to 59 months admitted with SAM to the treatment and feeding centreet Mayo clinic (MAYO - TFC) were randomized into ceftriaxone group and amox i-cillin group. Success was the proportion of children presenting an increased weightgain (WG) of at least 109/kg/day calculated over a period of 14 days starting as soon~sthe child's weight curve presented a first increase

<\ total of 460 children were included and randomized in the trial. Of them 228 werefollowed up in the ceftriaxone group and 230 in the amoxicillin group. The proportionof success for the primary outcome among the 458 children followed up was 56.1%(128/228) in the ceftriaxone group and 53.9% (124/230) in the amoxicillin group(Odds Ratio (OR): 1.01; 95%CI: 0.76 - 1.58). Results for exit outcomes for the 458children followed up were 74.6% (170/228) of children cured in the ceftriaxone groupand 70.0% (161/230) in the amoxicillin group (OR= 1.26; 95%CI: 0.82-1.93); CFRwas 3.1% (7/228) in the ceftriaxone group and 3.9% (9/230) in the amoxicillin group(OR = 0.78; 95%CI: 0.26-2.33)

The results of the study did not demonstrate statistically the superiority of short courseceftriaxone regimen on standard amoxicillin among children with SAM. Injection of

ceftriaxone was painful and administration of oral amoxicillin could be fastidious. Thechoice between these two types of regimen is therefore more related to operationalconsiderations. In time of massive arrival of children with severe acute malnutritionthe use of ceftriaxone would not only facilitate the work of medical personnel butwould also save more lives.

Hospital Treatment of Protein EmergencyMalnutrition Using Gezira Formula

Hassan Mohamed AhmedProfessor of PaediatricsFaculty of Medicine, Academy of Medical Sciences & Technology. Khartoum, Sudan

About 11 million children aged 0-4 die world wide every year and 99% are in develop-ing countries. Malnutrition is associated with 60% of these deaths. There is no unifiecpolicy in Sudan for dietary treatment of protein energy Malnutrition (PEM). Different hospital use different guidelines and different formula concentrations. Guideline)have been developed by WHO in improve quality of hospital care for malnourisheichildren.

This paper describes the treatment protocol of Gezira formula and comparing the ap-proach in use to WHO guidelines for inpatient treatment of severely malnourishe:lchildren.

The study period was about 4 years started on May 2000 and terminated in Marci2005. A total pf 351 children were included. History and physical examination wererecorded in standard sheets. All children were given Gezira formula by nasogastri,tube. All children were followed up by every other day weighing and daily monitoring of their general condition including heart and respiratory rates temperature. Initialformula with I gm protein and 70 kcal per 100 ml are give till signs of recovery occur,then maintenance formula with 3 gm protein and 130 kcal /100 ml is given till theirweight reach or approximates 85% of the standards.

Total numbers of children was 351, 7 children were excluded because their age wasmore than 5 years. 85% of children recovered and 10.8% died. The formula was foundto be effective even in treatment of very sever cases. The mean duration of stay in hos-pital was 13.5 day. The rate weight gain was 28.4 grams/day/person. These results are

comparable to international standardsAdaptation and a unified approach to treatment of PEM is suggested as WHO formulaingredients are not very available especially in remote rural hospital. The treatmentprotocol used is in total agreement with the WHO guidelines.

Neonatal Outcome in Severe Malaria with Pregnancy

Dr. Atif Bashir FazariConsultant of Obstetrics & GynaecologyFaculty of Medicine, The Academy of Medica/ Sciences & TechnologyatifJazari@hotmail.com. +249912385218.

Pregnant women are more vulnerable to malaria because of changes in the immunesystem during pregnancy. It known that malaria infection during pregnancy, inducea potentially harmful response, in the placenta and the foetus. This study designed todetermine the outcome of the neonates in cases of severe malaria. One hundred fiftyeight cases observed during acute malarial attack proved by positive parasite in periph-eral blood film with severe parasitaemia in different time in their third trimester. Thisobservation depends on different parameters studied here the most important of whichis the biophysical profiles by ultra sonogram.

Neonatal outcomes were: eighteen stillborn (11%). Sixty one low birth weight (38%).Forty seven with low Apgar score (29%). Thirty eight born prematurely (24%), eightof them, ended in early neonatal death.

Further multi-central studies with advanced measures are recommended to study thefoetal response during acute attack of malaria.

Neural Tube Defects: Incidence, Pattern and Short-TermOutcomeIn Omdurman Maternity Hospital, SudanDr. Ghada Eltahir and Prof. Salah Ahmed Ibrahim

In the developed countries a great improvement had occurred in the management ofchildhood illnesses which made the congenital diseases a major cause of infant mor-bidity and mortality, neural tube defects being one of them. In the last two decades agreat effort had been done on NTDs leading to reduction in their incidence.

The objectives of this prospective hospital-based study were to: determine the inci-dence of NTDs in Omdurman Maternity Hospital, describe the spectrum of NTDs,detect any associated congenital anomalies, assess the role of the socio-demographicfactors and to study the short term outcome ofNTDs.

All babies born in Omdurman Maternity Hospital during the period from the first ofFebruary 2003 to the 31 first of January 2004 with clinically detectable NTDs wereexamined and a consecutive birth was taken as a control.The surviving cases were fol-lowed up for the following three months.

The incidence of NTDs was 3.48/1000, 50% of the cases were myelomeningocele,38% were anencephaly, 10% were encephalocele and one case was iniencephaly. Mostof cases were either stillborn or died within the neonatal period. The male to femaleratio was 1:5, 20% of the NTDs had other congenital anomalies. About 55.5% of themothers were less than 25 years of age and there was a significant association betweenNTDs and mother age (relative risk 2.3p<0.000 1). Most of the parents of NTDs hadpoor educational background, 54.8% of mothers had a significant history of previousstillbirth delivery .Only 30% of mothers had antenatal care. No mothers from the caseor control group had used folic acid pre-conception.

It is concluded that the incidence of NTDs in Omdurman Maternity Hospital is thehighest in Africa and this invites a nationwide registry for all congenital anomaliesand improvement in obstetric services including active promotion of folic acid sup-plementation programs.

Sample Evaluation of Medical Schools in SudanCollege Of Medicine, University of Juba

Walyeldin EI-Nour EI-Fakey, MD, Assistant Professor U of 1, Nour Elhuda Attalla, MD Assist-ant Professor U of 1, Mohamed Essa, PHD, Assistant Professor U of 1, Mohamed YousifSukar,Ph. D, Professor U of K, Abdelrahman H. Elmufti, MRCp, DCH, Professor U of J

In this study the world federation of medical education standards are used to evaluatethe curriculum, educational program and available resources in collage of medicineuniversity of Juba.

To assess the curriculum and effectiveness of methods used in teaching, and to studyif the educational programme and the staff meets the basic and developed standardsof medical education. More over this study shows the strong aspects to be encouragedand the weak points.

Cross sectional analysis of available data testing the World Federation of Medical Edu-cation standards.

Data collected form documents available at the university and collage, questionnaire tothe staff and students and interviews with department heads.As for the basic aspects of the standards collage of medicine, university of Juba scoreda general average of (81.3%). The weakest aspects here are those which concern theavailability of full time technicians at hospital, patients care and mechanisms of pro-gram evaluation.

As for the developed aspects of the standards, the Collage of Medicine of the Univer-sity of Juba scored a general average of (60%). The weakest points here are full timetechnicians at hospital; patients care potential educational resources and mechanismsof program evaluation.

The curriculum and availability of resources at the collage of Medicine University ofJuba are acceptable but not to the level of what stated in the collage mission and objec-tives.

Key words: standards, education, medical, method, basic standards developed stand-ards, World Federation of Medical Education.

Echocardiographic Findings in Sudanese Childrenat Ahmed Gasim Centre

Dr. Siham Ahmed Hassab ElrasoulCons passed Cardiologist. Ahmed Gasim Cardiac Centre(MD. MRCP, MRCPCH. DiP PAED CARDIOLOGY. BCH)

The aim ofthe study is to describe the pattern of heart disease both congenital and acquiredin Sudanese children attending the paediatric cardiology clinic at a Gasim Cardiac Centre.

The study is a cross-sectional study involving three hundred children age -0-15 yrs,attending the clinic at a Gasim Hospital. The study duration is from December 2004-May 2005.

The study showed that the predominant cardiac disease is rheumatic heart disease.Commonest rheumatic cardiac lesion was mitral regurgitation. Among the congenitalheart VSB was the most predominant.

Sudan, being an underdeveloped country, still has a predominance of rheumatic heartdisease which is a major cause of morbidity and mortality in children. The cost of car-diac surgery is an added obstacle in the treatment of children with heart disease wheth-er rheumatic or congenital. The implementation of a proper rheumatic fever controlprogram and increasing the awareness of the population for seeking medical advice forthese children is extremely essential and is the corner stone for reducing morbidity andmortality. Governmental fund to support rheumatic fever control program as well assupporting cardiac surgery for children is extremely essential.

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Child Health in South Sudan:Previous Experience and Future Prospects

Patterns of Paediatric Mortality in JubaProf. Mabyou Mustafa Abdel Wahab

Out of a total number of 7092 admissions at Sabbah Children's Hospital, Juba, Sudan,in the period between June 1984 and May 1986; 675 (9.5%) died of whom 55.4% weremales and 44.6 % were females. 53 % of those who died were under I year of age and92.6 % were below five years of age.

The main causes of death were identified as gastroenteritis, respiratory infection, mea-sles, and tetanus, which together accounted for 58.4 % of all the deaths. Malnutrition,especially the sever forms of kwashiorkor, marasmus-kwashiorkor, and marasmus ac-counted for 13.2 %.

Malaria and central nervous system disorders accounted for 7.7 % and 7.9 % respec-tively.

Tetanus was rampant. It alone accounted for 16 % of all the deaths. Tetanus neonato-rum accounted for 87 % of the cases of tetanus. 73 % of all the deaths occurring in theneonatal period were due to tetanus neonatorum.

Health education, activation of the expanded programme on Immunization and otherpreventive measures should be embarked on. People should be enlightened about theimportance of early reporting to medical care so as to reduce childhood mortality inthe Juba are.

Post war strategies for child survival should reinforce and stress on the following:1. Maternal and child health programs.2. Health education programs.3. Good obstetric care.4. Control of infectious disease.

These should be coupled with:-1. Rehabilitation of the existing health facilities.2. Establish children hosp. in Wau, Malakal & other main cities in Southern Sudan.3. Embark on in-service training of staff dealing with child health.4. Southern Medical Schools should go back to function in the south.5. Strengthen the PHC programs and make them efficient.

Patterns of Severe Malaria in Sudanese ChildrenZeidan Zl, Kojal H2, Habour M3,Nowary K4, Hashim F5, Erikson 86

1Associate Professor, Community Medicine Department, University of Khartoum2Assistant Professor, Paediatrician, University of Is lami a3Pro(essor, Paediatrician, University ofGezira4Paediatrician, Gedarif Hospital5Paediatrician, Sinnar HospitalNordic School of Public Health

Correspondence:Zeidan Abdu, Zeidan, Associate Professor, University of Khartoum, Community, Medicine Depart-ment, PO Box 102, Khartoum, Sudan

The objective of this study was to assess treatment actions before admission lex severemalaria, epidemiology, clinical presentation, disease management, outcome and risk factorsassociated with fatality.

Follow up prospective design was used to fulfil the objectives of the study that took place infour hospitals: Omdurman Paediatrics hospital located in the capital (Khartoum) Comparedto Medani, Gedarif and Sennar hospitals located in other states.

Total admission of severe malaria was 543 children; it represented 21% of all paediatric ad-mission, and 12% of malaria outpatient cases. Madigan age of children with severe malariawas 48 months. 93% of children with severe malaria died before the age of 9 years. Treat-ment at home was the first action taken by families before hospitalization (58%), majorityof actions (75%) were done by mothers. Health services at local level were available onlyfor 34% of the largest groups. Cerebral malaria judged by convulsion and eoma (83%) wasthe commonest complication; it had significantly different distribution in different stats i.e.with different epidemiological context.

Case fatality rate was 26/1 000. Risk of dying because of delay was four more times com-pared to children without delay, 95% Cl (1.5 - 14.3). Highest risk of death was associatedwith delay in seeking treatment and severity of the illness before admission (coma, inabilityto sit or eat and hyperpyrexia).

Omdurman hospital in Khartoum state (the capital) witnessed the highest case managementperformance index compared to other states hospitals.In view of this, we conclude that malaria could be reduced by improving peripheral healthfacilities, train mothers on malaria home management and providing appropriate educationto communities to avoid delay in seeking treatment. Malaria control strategy should con-sider the different epidemiological contexts in different states in Sudan.I

Balloon Valvuloplasty for Critical Neonatal Aortic Stenosis: Ini-tial Results and Long Term Follow-up

O. H. EL Shazali, J. J. O'Sullivan, D. S. CrosslandPaediatric Cardiology, Freeman Hospital, Newcastle upon Tyne, UK

The purpose of this study is to assess the safety and effectiveness of aortic valve bal-looning for critical neonatal aortic stenosis and to look at intermediate and long termfollow up.The study is a retrospective review of notes, echocardiograms and haemodynamic dataof all babies (less than 3 months of age), treated at our institution between August 1985and December 2002.28 babies underwent balloon valvuloplasty for critical aortic stenosis, mean age was 25days (range 1-89), mean weight was 3.3 Kg (range 2.1 - 5.6), mean follow up periodwas 6.3 years (range 0.5 - 16 years).There were 7 deaths (25%), all of them occurred within 4 weeks post ballooning, 3of them had severe heart failure and were ventilated and on inotropic support withevidence of multi-organ failure pre-ballooning. There was no death within the last 5years.8 babies developed significant aortic regurgitation and 12 babies had significant re-sidual aortic stenosis and 2 of them needed re-ballooning, one at 1 year of age and thesecond one at 2 years of age.4 patients underwent Ross procedure at 4,9, 10, 10 years of age.Conclusion: Ballooning of neonatal critical aortic stenosis is associated with signifi-cant mortality and morbidity especially in very sick neonates, patients should haveregular and long term follow up.

Audit of Management of Sickle Cell CrisesIn Children in a London Hospital

Dr. Abdelmoniem Mohamed Hamid, MBBS, MRCPCH.Consultant Paediatrician, Kettering General Hospital, Kettering, UK

Africa is the birthplace of sickle cell disease with millions with sickle cell trait, andnewboms affected by sickle cell disease (SCD) are estimated at 200,000 per year.The disease is also prevalent in variable degrees in other parts of the world includingUK, USA, the Caribbean, the Mediterranean, Saudi Arabia and India. There are about10000 in UK. Whereas management of children with SCD in the developed world iswell structured and organised by protocols and close follow up, it is lacking behind inAfrica.

Aims: To evaluate the management of acute sickle cell crises in children attending .I

London Hospital in line with the available hospital guideline.'.Methods: An Audit of the care provided was done by retrospective data collection lee',case notes or 43 Children aged 0- Ioyrs, presenting with acute sickle cell crises to tl.cLondon Hospital over 5years period (between April 96 to April 200] ). Tnere were ':::.:males (5~%) and 1~ females (42<Yo). A questionnaire was completed.

There were 24 (56%) Black-Africans in the studied group. Black Caribbean's wcr.6 (14%).77% of the cases were HbSS whereas IibSC represented .23(~(l. Out o: i~5presentations 120 (96~o) were on prophylactic penicillin at nrcscntation l-ueumoc:cal vaccine had been received by 24(56(~;J) ofthe natients. 17 children t4()o.,,) did n·lreceive the vaccine. With reference 1;~the national standard», there \\ ,h detay i» . i

tiating analgesia. and a long wail ne (ore a doctor say. those children attcndmg A&' .The most common diagnosis wa .-; vase-occlusive (painful) crisis In Xl) prescntauor.,(72%). Septicaemia occurred in i< presentations 16%). pneumonia In t; ! (/>.1)1 and sicl.i :chest syndrome in 8 (M'-;»). Hb on pI escntation \V213within nO!"~lIJ! range' t(~r tnc m1ll'·-t

«1 gm drop) in 102 (85%) cases and low in 1r,;( I J" i .Biood transfusion was requi!'_Jonly in 12 (10%) of admitted children.The overall management of children with acute sl~'k< cc'l :T!~V, mcscming It :.>

London Hospital had been good, but some aspect: ,,,I" "-'''lla~'CmC'lllh~;',t imDr')'Cmc;,

There was delay in initiating management when c/l;Ur:n :::''''',dc.! 'J ; '\',h crisc.,The majority of children were receiving prophylactic pl'J:i(i,:" anu t]1\:1",' VI", iow ra:eof severe infections. Though many had had pneumococca: ,;~"cir.-' hut lh~'"',was n·)organized programme to immunize all.

Management of sickle cell disease in children in Africa and other developing countriesneeds to be revisited. More epidemiological studies and research are needed, besidesimplementation of structured management protocols to reduce morbidity and mortalityin these children.

Medical and Psychosocial Aspects of Children in Reformato-ries

Sanaa Kalid Mukhtar

This study is a descriptive, prospective institutional based study, comprised of 120detained children in Kober and Elgeraif reformatories. The study was conducted fromJuly 2003 to January 2004. The Objectives of this study were to detect the common

medical problems, to assess the psychosocial profile and to identify factors associatedwith offending.

Self administered ISAAC questionnaires with supplemented question on socio-demo-graphic data, drug history (substance abuse); features of both medical and psychiatricproblems were included.

Detailed information about the offence was stated. Another questionnaire; strengthand difficulties questionnaire which is a behavioural screening covering items on psy-chosocial attributes has also been administered. Complete physical examination wasrecorded.

The age of the detained children ranged from 10-17 years. There was obvious malepredominance in the study. The majority of children belong to Fur (49%), Nilotics(26%) and Gaaleen (17%) tribes. Most of the parents were from states other than Khar-toum (61%). The majority of the children belong to low social classes (94.2%). Themain reasons for placement were condemnation (43.3%) which was mainly due tofinancial causes (27.9%).

The most common health problem was substance /a1cohol abuse which was reportedin (54.1%), followed by dermatological conditions which accounted for (30.8%). In-testinal parasitism was reported by (1l.6%). Enuresis was found in (11.6%), schisto-somiasis affected (6.1 %) and upper respiratory tract infections which were suffered by(6.7%). The prevalence ofHBV was (4.9%). Psychiatric disorders were diagnosed in(40%) which were mainly conduct disorders (33.3%), with an overlapping betweendifferent types of psychiatric disorders. Being an offender was significantly (P.value < 0.000) affected by the state of poverty; however, it was not affected by thestate of being from very large families, other offender in the family, poor education orrepeated offending.

It is concluded that the common health problems are substance/alcohol abuse, derma-tological problems and intestinal parasitism.Psychiatric disorders were diagnosed in 40% of the children with conduct disorders(83.3%) being the most common.Being an offender is significantly affected by the state of poverty (P. value < 0.000).

Update in Paediatric Hypertension

Hypertension is one of the major contributors to cardiovascular, renal and central nerv-ous system morbidity and mortality.Although it is more prevalent in the adult population, hypertension and its complica-tions are being seen in the paediatric population with increasing frequency.

Hypertension is usually asymptomatic in children; so routine BP measurement as partof the general examination is vital in preventing later mortality and morbidity.

Measuring blood pressure in childhood can also identify people who will develop hy-pertension later in life.

In this presentation we will discuss

- Epidemiology- Measuring Blood pressure- Diagnosis- Investigation- Management

MR Imaging of Spinal Dysraphism

Mamdouh Mahfouz, MD

Congenital anomalies of the spine are collectively included under the title of spinaldysraphism.This presentation will try to cover the diagnostic role ofMR imaging in the assessmentof different lesions in encountered in this domain.Meningeal abnormalities as well as spinal cord lesions will be demonstrated and dis-cussed.A diagnostic protocol will also be recommended by the end of the presentation.

Patterns of Childhood Epilepsy in the Eastern Province in SaudiArabia

Dr. El Sayed AIi, FRCPI, DCH, Dip Neur (Lond)Consultant Paediatric NeurologistKing Fahd Military Medical Complex (KFMMC)

ObjectiveTo determine the distribution of various epilepsies and epileptic syndromes in Saudichildren treated in King Fahd Military Medical Complex in Dhahran. An epilepsyClinic was set up in 1999 for all children with a history of seizures or epilepsy, referredfrom within KFMMC hospital, Air Base Hospital in Dhahran, Naval Base Hospital inJubail and Security Forces Dispensary in Dammam.

MethodData concerning 300 children aged 2 months to 14 years with epilepsy seen betweenAugust 1999 and September 2004 were analyzed using the International League againstEpilepsy (ILEA) classification. Nicolet Alliance Works 23 Channel Digital EEG ma-chine with Video Recording was used.

ResultsA total of300 children were recruited into the study. The median age at the time of firstseizure was about 5 years. 49% were male. In this childhood - onset cohort, 46.6% ofthe syndromes were localization related. 30.3% generalized, and 23.1 % undeterminedas to whether focal or generalized. Benign Rolandic and Occipital epilepsies occurredin 12% of partial epilepsies. Myoclonic epilepsies of various types are the leadingcause of generalized epilepsy. Childhood absence epilepsy was the most commonsyndrome in primary generalized epilepsy. Infantile spasms were the commonest inthe secondary seizure group. Neuroimaging was performed in all patients with partialepilepsies and epileptic encephalopathy.The most common treatment strategy for generalized epilepsies was initial Valopratemonotherapy. In partial epilepsies, Carbamezepine was the drug of first choice. Thenew AEDs (Lamotrigine and Topiramate) were used as second therapeutic mode, ei-ther as monotherapy or add - on. Infantile spasm cases were treated initially withVigabatrin.

ConclusionThis study presents a description of childhood and adolescent onset epilepsy as it isdiagnosed and managed in our hospital.

The Role of the Paediatric Diabetes Specialist Nurse

Dr. Asaad T. EI-Abbas (EI-Srurabi),MBBS, MMS, MRCP + DCHConsultant Paediatrician, Mayo General Hospital,Castlebar, Co. Mayo, Ireland

* Diabetes is the commonest endocrine disorder of childhood, and is a life longchronic condition.

* 20,000 people under the age of 20 years with diabetes in the UK

* The incidence of diabetes in childhood is increasing, and the onset is occur-ring at a younger age.

* The demand for Paediatric Diabetes Specialist Nurses is likely to continue infuture years.

* PDSN is the hub of the Diabetes team.

In order to provide and deliver a high quality paediatrics diabetes services PDSNS+along with other team members need to consider certain priorities:

1. Having a clear philosophy for team approach.2. Having guidelines of practice for the clinic and in-patient unit.3. Promoting ongoing education involving:- the child / family- other health professionals in the hospital or community settings.4. Facilitating and co-ordinating effective care.5. Taking responsibility for personal development needs.6. Monitoring the service offered by audit, i.e. by measuring the efficiency, ef-fectiveness and economics of the service according to resources available.

Background and History:

* The first nurses with specific responsibility for patients with Diabetes wereinvestigated in the early 1950's in Leicester, known as "Diabetes Liaison HealthVisitors" .* The first posts were developed in 1970.* Nurse practitioners developed in America in the 1970 and subsequentlyevolved into specialist nurse educators.* In Australia the first paediatric diabetes education was appointed in 1978.* In France they are all hospital based.* In Sweden Doctors and Dietician's are the major educators.

Summary and Conclusions:

The role of the PDSN is varied and at times complex.The following attempts to list the principal e1ements:-

I. Clinical Care.2. Liaison with:- School- Primary Health Care Teams- Employers3. Teaching- Children and Parents- General Practitioners study day- Nurses- Ward staff up date- Teachers4. Advocacy and counselling5. Organisational skills.

Clinical and Echocardiographic Featuresof Ebstein Anomaly in Sudanese Patients,High Prevalence and Unreported Associations

Sulafa KM Ali, Nuha A AlnumairiSudan Heart Centre

Ebstein anomaly (EA) of the tricuspid valve is a rare congenital heart disease thatconstitutes about 0.5% of all congenital heart disease. This study is a prospective fol-low up of all patients with EA seen at two cardiology clinics (Sudan Heart Centre andJafaar Ibn Ouf Children's Hospital) from July 2004 to March 2005. Diagnosis of EAwas based on the echocardiographic demonstration of apical displacement of the sep-tal leaflet of the tricuspid valve by > 8mm/m2 with abnormal attachment of the septalleaflet to the interventricular septum.Results: In a 9 months period we identified 13 patients satisfying the criteria for EA.EA constituted 1.2 % of all patients with congenital heart disease. The age ranged from2 weeks to 35 years with a mean of 12 years. Five patients (38%) were asymptomatic.Seven patients (53%) presented with CHF, 4 were in NYHA class Ill-IV and 3 were

in class 11. 4 patients (30%) presented with cyanosis in addition to heart failure. Onepatient presented with palpitations.A wide range of associated diseases included chronic renal failure, impaired hear-ing, and growth failure with a characteristic facial appearance in males. Electrocardio-graphic abnormalities included peak, tall P wave (83%), Rsr pattern, first degree AVblock, atrial fibrillation, Wolf-Parkinson- White (WPW) and Mahaim type pre excita-tion. Associated echocardiographic abnormalities included mitral valve prolapse, leftventricle dysfunction, secundum atrial septal defect (ASD), pulmonary valve stenosisand pericardial effusion. One patient had tricuspid valve surgery and 3 are waiting forsurgery. 2 patients are awaiting trans-catheter ASD closure.Conclusion: The frequency of EA in this area (1.2 % of all congenital heart defects) ismore than double the average reported frequency. Many of associated diseases had notbeen reported in the literature.

Enuresis Clinic

Dr. Abdelazim Mohamed Mabrouk,MBBS, MPCH. DCH. CABPSpecialist Paediatrician. AI Ain, United Arab Emirates

Enuresis is defined as the involuntary voiding at an age where urinary continence isexpected. It can be primary, secondary, nocturnal, diurnal, poly or monosymptomatic.

The commonest type is the primary monosymptomatic nocturnal enuresis. This is de-fined as a complaint of bed wetting since birth and occurring during sleep without anyperiods of dryness in a child older than 5 to 6 years. It is not associated with symptomsof urgency, frequency or day time wetting. This represents more than 80% of cases.Numerous hypotheses had been suggested to explain the aetiology of this distressingproblem. The most acceptable one is the genetic predisposition where Nocturnal enu-resis was observed to run in families. Recently, the gene locus was identified to be inchromosome 13q and an autosomal eo-dominant mode was suggested. In those chil-dren there was a lack of nocturnal secretion of the antidiuretic hormone vasopressin,resulting in large urine production at night. Children with overactive small bladdercapacity void small quantities of urine at intervals during the night.

It was preferred that these children should be managed in a specialized enuresis clinic.This clinic provides evaluation and management for affected children who are abovethe age of six years. It adopts different management approaches including motivationaltherapy, behavioural modification and pharmacological treatment. It also provides in-

formation to parents and children and helps them to understand the problem, reinforcethe positive behaviour and discourage the negative one, and to become involved inthe effort to alter night time routines. The clinic should be run by a Paediatrician withspecial interest in treating enuretic children, and a specialist nurse who had adequatetraining and experience in the subject.

The presentation will include the experience and statistics of the enuresis clinic in AlAin, United Arab Emirates, Also, a plan of management which can be a model to fol-low in dealing with these children will be suggested.

Evidence for Management of BabiesBorn to Mothers with Hepatitis C Infection

Dr. Abushouk

Hepatitis C Infection is a common disease. The number of children acquiring the dis-ease transplacentally is increasing. There are few guidelines on how to manage thesepatients, however there is a wide variation in clinical practice.

Methods: Extensive literature review including 119 references looking for the evi-dence on how to monitor such babies.

Results: there is little evidence on how to monitor this group of babies.

Conclusion: Large studies are needed to answer several questions on how and when totest these babies and how to interpret the results.

38 •• 00

The Pattern of Childhood CancerIn Children Admitted to the Institute of Nuclear Medicine,Molecular Biology and Oncology-Wad Medani

Dr. Huda Haroun

Introduction:

Reports on the pattern and incidence of childhood cancer in Sudan are rare. Althoughcancer in children remains one of the major causes of death due to diseases betweenthe ages of 1_15 years, the pattern in Sudan is still not yet determined, the incidenceis not known.

Objective:

the objective of this study is to know the trend of cancer in Gezira which can give a hintto the trend in Sudan and compare it the international pattern.

Method:

The study is a retrospective study using the institute registration.A total of 190children aged less than 15years diagnosed by means of histological orcytological examinations during the period May 1999_ Dec2004.

Results:

The result showed a trend like an afro-asian rather a western pattern .with male tofemale ratio of (1.8: I} .with lymphomas constituted the highest prevalence( 42.8%)followed by acute leukaemia (23.7%) and kidney tumors (12.8%) .With kidney tumorand retinblastoma common in under five and lymphomas, leukemias and bone tumormore prevailing at the age group more than five years. Lymphomas leukaemia andkidney tumor are more common in males than females.There is no specific cancer which is more prevalent in certain tribe or area in theGezira.

Recommendations:

we need to know the percentage of deaths the incidence yearly the degree of survival

The Importance of EEG for the Paediatrician

Dr. Taha Sadig AhmedMBBS (Khartoum), PhD (Bristol, UK), Member of (AANEM),Associate Professor, College of Medicine,Consultant, Clinical Neurophysiology, King Abdulaziz University Hospital, King Saud Univer-sity, Riyadh

The EEG, in general, is important for (I) confirming and documenting whether thereis a brain abnormality or not. For example in cases of sudden movements, myoclonusor startles, especially in the very young, the physician and parents need to ascertainwhether these are normal movements ( normal EEG) or are part of a subtle seizure(abnormal EEG) (2) Identifying whether the abnormality is focal, lateralized or gener-alized (3) This will help in classification, which sheds light on the appropriate medi-cation, and (4) tells about the prognosis. (5) Serial, follow-up EEGs tell the Physicianabout whether there is improvement, deterioration or evolution of the epilepsy (6) EEGis important for identification of other neurological conditions such as HSE, SSPE,etc. (7) Study of sleep disorders, and confirming whether they are part of normal phe-nomena or related to subtle seizures (8) Help in Child Psychiatry and differentiatingbetween genuine seizures and pseudo seizures. Sleep studies,

The Paediatric EEG differs from adult EEG because the electrical activity of the brainchanges with cerebral maturational changes during growth and development. EEG mat-urational changes were first reported as early as the 1930s by Smith (1938) and Lind-s1ey (1939). However, the major studies took place much later ( e.g. Matousek,1968;Mathis et al , 1980; Gasser et. aI. , 1988, Clarke et al 200 I ).Beside the age-specificdevelopmental physiological changes in the EEG , children develop different patho-logical conditions that are different from adults and are often also age-specific . In-terestingly, several researchers (e.g., Mathis et. aI., 1980; Benninger et. aI., 1984;Harmony et. aI., 1990; Diaz et a11998) report differences in EEG maturational featuresbetween boys and girls. The EEG recording itself is different in children than adultsbecause the brain, meninges, skull, scalp, head size as well as the child's behaviour andability to cooperate all change over time. Therefore, Paediatric EEGs must be recordedand interpreted bearing in mind normal as well as abnormal features for each age, fromthe newborn to adolescence. The Paediatric EEG, its own normalities, curiosities andabnormalities will be discussed, and most of the data will be from our clinic in KingAbdulaziz University Hospital, Riyadh, Kingdom of Saudi Arabia.

Pattern of Valvular Involvement in Rheumatic Heart Disease

Samia Hassan

Rheumatic heart disease remains a leading cause for morbidity and mortality fromcardiac diseases in Sudan. The objectives of this study were to describe the pattern ofvalvular involvement in patients with RHD, correlate the pattern of valvular involve-ment to the course of the disease and study the correlation between the social impacton the child and family to the pattern and severity of the valvular lesion.

A cross - sectional hospital based study was conducted on three days a weak basisfrom the period of 24th of June to 24th of November 2003 in Ahmed Gasim TeachingHospital and Al Shaab Teaching Hospital. One hundred cases with documented RHDwere studied; full history, thorough examination and Doppler echocardiography weredone for each child. The result showed that RHD was confined mainly to rural and per-iurban areas (in 94% of cases), with poor housing conditions and overcrowding. Thenumber of persons/room was 6-15 in nearly two thirds of the cases.

Most ofthe cases (93%) had mitral valve involvement: in form ofMR in 36 cases, MSin nine cases, MR + AR in 23 cases, MR + MS in 15 cases, MR + MS + AR +AS ineight cases and MS +AS in two cases. There was no significant relationship betweenhistory of rheumatic fever and the severity of valvular involvement (P=0.202), whilethere was strong association between irregularity in prophylaxis and development ofcomplications like pulmonary hypertension (P<O.OOI) and significant haemodynamicchanges on the heart.

Almost half of the cases (51%) had either pulmonary hypertension, severe lesions andsignificant haemodynamic changes on the heart, putting them as candidates for surgerywith the hazards of complications of prosthetic valves in such a group of children liv-ing away from sophisticated medical services.

There was a significant burden on the families and their children as almost all the fami-lies (98%) were affected by the money spent on treating their of children and two thirdsof children had limited activities at home and school.

We recommend improvement of housing conditions, early detection of cases withRHD and regular use of prophylaxis as it might be the only intervention that could berealistically implemented and cost effective.

Paediatric Tuberculosis: Diagnosis and Treatment

Haitham El Bashir, Consultant PaediatricianGreat Ormond Street Hospital & Haringey Primary Care TrustEmail: haithamelbashir@hotmail.com

Tuberculosis is one of the major infections affecting children worldwide. It causessignificant morbidity and mortality, especially in infants and young children. Recently,there has been a global increase of tuberculosis in both resource-limited and some re-source-rich countries. HIV infection, overcrowding, poverty and immigration are pos-sible contributory factors for such increase. At present, there are 2 billion individualsinfected with the organism, and 1.8 million people die each year.

The diagnosis of tuberculosis in children can be difficult as traditional investigationsmay not always be positive. This paper discusses the epidemiology, diagnosis (old aswell as newer diagnostic methods) and treatment of the disease in children, includingtreatment of latent infection and chemoprophylaxis of household contacts. The paperalso highlights the new vaccines currently in development.

IVF Babies

Dr. Zein ab Mohammed GailyPro! Zein El Abdeen A/Rahim KarrarDepartment of Paediatrics and Child HealthUniversity of Khartoum

This is a prospective hospital based comparative study in Sudan including 96 IVFbabies.

The most important objectives of this study include assessment of birth parameters ofIVF babies, common medical problems among them during the neonatal period, inci-dence of multiple births and congenital malformations among them. It also addressedthe psychosocial impact on the mothers.

It demonstrated that IVF babies had lower birth weight compared to normal concep-tion babies and confirmed that IVF babies had high incidence of multiple birth. Theincidence of congenital malformations was equal in both groups. The common medi-cal problems were due to prematurity rather than the IVF method itself. The mothersin this study had an increase in their self-esteem, their relation with their husbandsbecame more intimate and also with their families and neighbours. The majority of themothers refused to declare the society about their IVF baby.

Guidelines for echocardiography

Elfatih Abozied

Echocardiography is the most useful diagnostic tool in cardiology due to its wide avail-ability, non-invasiveness, the vast information it provides, cost effectiveness and reli-ability. In spite of all that this modality is utilised indiscriminately.

In advanced countries indication guidelines were made for requests of echocardiogra-phy.

Review of the requests in 3 clinics for paediatric cardiology in Khartoum from May200 1to April 2005 revealed a sizeable number of requests which can beclassified as inappropriate.

In Sudan this investigation is still expensive and time consuming. Many requests aremade by junior staff where a senior staff may save the patient the trouble.

The paper discussed a draft proposal for local guidelines for ECG requests.

Acute Flaccid Paralysis Presenting at Children Emergency Hos-pital, Port Sudan, 2004

Khalid Mohamed Khair,MBBS

Red Sea State is one of the least developed in the whole Sudan. According to (1999)estimates its population is (735,800). Children under five are 138,183. Below one yearof age estimate (22,074).

The data had been collected over one year period when AFP became a major healthproblem in 2004 among children under five of age.

Total number of AFP was 65 established acute poliomyelitis were 23 cases represent-ing (35.5%) of total AFP admission. Vaccination status of the study group, (56.9%)were not immunized while (12.3%) were partially vaccinated indicate poor vaccinecoverage in the state.

Only (3%)of the study group attended more than 6 rounds ofNIDS. (64.6%) attended less than3 rounds.

There was male predominance (1: 1.2), (32.3 %) of the cases were between 12-24months. However, attack rate was lower (16.9%) among infant below one year. Above5 years of age represent only (9.2%) of affected children.

The onset of paralysis prior to admission is shorter in this study (35.3%) had paralysisonly between 1-3 days. Only (1.5%) presented after 2 weeks from onset of the paraly-SIS.

Stool for viral study showed (33% ) were type 1 polio virus, (1.5 %) showed type 2. only (3% ) were non-polioenterovirus .

Flaccid paraplegia is a predominant clinical feature (56%). Respiratory and CNS in-volvements reported in (3%) of cases. only (41%) remain with residual paralysis after60 days of clinical assessment.

Full recovery was achieved in (53%), acute myositis cases were (3%), hypokaiemia(4.5%), Gillian Barre Syndrome were (6%), and cerebral malaria were (3%).Mortality was (3%) due to acute respiratory paralysis.

A Clinical Governance Model:A Recipe for Change to Better Practice

Dr. Hadi Almalik

In attempt to improve the Patient care and work towards clinical excellence, there is alot of initiative taken up by developed countries.

Clinical Governance and variance methods to implement it are one of the best of theseinitiatives. Thinking with open mind and a vision to the future we need to look to oth-ers experiences and learn from them.

Clinical governance defined as: "A framework through which Health organizations areaccountable for continually improving the quality of their services and safeguardinghigh standards of care by creating an environment in which excellence in clinical carewill flourish"

It works through the following Main Pillars:

Evidence Based PaediatricsProfessional DevelopmentClinical AuditClinical Risk ManagementClinical InformationClinical Guidelines

The RAID (Review, Agree, Implement and Demonstrate) Model is an ideal one forapplying and supporting the Clinical Governance Agenda in the clinical as well asoperational aspects of the child and his family Care. That can be carried out througha small team in each hospital, Can be called Clinical Governance Support group. It isvery effective way to overcome the Challenge of Change towards the best care of ourchildren services in Sudan.

Dengue Haemorrhagic Fever in Port Sudan Locality

Dr. Amel Aziz Malik, MD. (Paediatrics)Head Dept. of Paediatrics, Faculty of Medicine, University of Red Sea

Dengue is the most important emerging tropical viral disease of humans in the worldtoday. It is a mosquito born disease transmitted by Aedes aegypti. WHO(l999) esti-mated that there are 2.5 billions of population worldwide are at risk of contracting thedengue fever where 50 to 100 million cases of dengue fever(DF)and about500,000cases of dengue hemorrhagic fever (DHF) each year which require hospitalization.Since 1967 DF has been reported in Sudan (WHO 1997), DF type 2(not DHF) wasdiagnosed virologically in Port Sudan locality in 1986 and 2003. Objectives: To studythe pattern of emerging DHF in Port Sudan.

This study was conducted in Port Sudan Paediatric Hospital and SPC Hospital in theperiod 111112004 - 30/6/2005. Most of the cases of suspected DHF according to WHOcriteria (Excluding tourniquet test) were included in this study.

Data were collected from 307 cases of suspected DHF 188(61.2%) male and 119(38.8%)female between the ageS-month to IS years. [Mean age 7.5 years old].

Clinically all cases in our sample presented with fever [100%] of 4-7 days duration,(68%) presented with easy bruising and bleeding at vein puncture site and/or petechi-ae in skin, mucous membrane and bleeding from other sites,(33.2%)with epistaxis,(36.5%) with haematemesis and (27%) malena. Dengue shock syndrome (DSS) wasdiagnosed in 32 cases (9.1 %).The mortality rate was (2.2%).

Platelets count was done in 280 pt thrombocytopenia (platelets 100,000 cells/cu mmor less)found in (69.5%) of them, u/s abdomen was done to 36 cases and 16 patienthave pleural effusion and/or ascites .Sample for serological test were collected from82 cases and 35 samples were discarded due to haemolysis. Dengue IgM antibodieswere detected in 37 cases, 10 undetected (possibly due to inappropriate time of samplecollection).

Preventive measures should include community participation, environmental manage-ment of the vector control tools, education of health personnel and improvement oflaboratory facilities.

Dyskeratosis congenital 111 a Saudi hoy . I. Y. Saadeldin et al.

Case reportDyskeratosis congenita (DC) in a Saudi boy: anuncommon genodermatosis

I . Y. Saadeldin, Satti A. Satti. Ali S. Dammas

Pcdiatric & Nconatology Department. King Fahad Hospital at Al-Buha. AI-Baha.Saudi Arabia.

Abstract A 6-year-old Saudi boy presented to our hospital with severe thrombocytopenia. Thepatient was managed for a long time (6 years) as having chronic idiopathicthrombocytopenic purpura. Luer on features consistent with dyskeratosis congcnnawere recognized by the authors. The main features were: skin manifestations. naildystrophy. alopecia total is, microcephaly and mental retardation. The condition wasassociated with acute necrotizing ulcerative gingivitis. At the age of 10, he developedpancytopenia and died at the age of 1.+years from acute fulminant sepsis.

Key wordsDyskeratosis cungcnita. acute necroti/ing ulcerative gingivitis. pancyiopemu.

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Engeri.x"·B is a recombinant vaccine containing the surface antigen (HBsAg)of HBVat high puri~·. HBsAgitseli is non-infectious, as the infectious part ofthe rirus is its core. Exposure to HBsAgat sufficient doses provides effectiveprotection against the lirus.

Clinical trials hare shown that Engerix"·B (20 ~g!dose) leads toseroconrersion in 98% of healthy adults. The immunogenicity andprorective efficacy of Engerix"·B have been confirmed in neonates,children, adolescents and adults. Anti-HBs antibodies have been shown ropersist at adequate titres for at least; years after raccination. EngerixiX.Bhas an excellent safe~' profile and is well tolerated.

Engerix"'·B is arailable in dose forms containing 10 ~g or 20 ~g ofHBsAgper dose. These are recommended for children and adults. respectivel): Therelatirel)' large amounts of HBsAgin each dose hare been shown ro prorideprotection more rapidl)' and longer·lasting persistence of protecrire leve~of antibodies from HBr for normal indi\iduals than lower doses. £quallj~the recommended doses of Engerix 'W.B are beneficial for those indilidua~with a poor immune response (non·responders) due to a ranet. of factors.including older age, male gender, obesity and smoking.

Immunocompromised people, such as those ~'ith renal disease or HIVinfection, need special regimens of Engerix"·B inrolring higher doses ofantigen (up ro ,,0 ~ dose), the use of which has been raJidated in clinicaltrials.

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ZENTEL (albendazole)

Prescribing Information

PRESENTATION

Zentel is available in tablet and suspension formswith 400 mg or 200 mg Albendazole tablets and4% or 2% Albendazole in suspension.

USES

Zentel is effective against the intestinal protozoalparasite Giardia lamblia (intestinalis orduodenalis).

Zentel is also a broad spectrum anthelminthic forthe treatment of:Enterobius vermicularis Pinworm or

threadwormTrichuris trichiura . . ...WhipwormAscaris lumbricoides . . . .Large roundwormAncylostoma duodenale . HookwormNecator americanus ..HookwormStrongyloides stercoralisHymenolepis nanaTaenia spp .. ..... Tapeworm

in single or mixed manifestations of any of theabove.

Albendazole may also be used for systemichelminth infections: the appropriate data sheetshould be consulted when treating hydatiddisease, cysticercosis and other systemicinfections.

DOSAGE AND ADMINISTRATIONUnder medical prescription

In cases of giardiasis: Zentel 400 mg as asingle daily dose should be given for 5 days.

In cases of Enterobius vermicularis, Trichuristrichiura, Ascaris lumbricoides, Ancylostomaduodenale and Necator americanus the usualdose in both adults and children over 2 years ofage is: 400mg (two 200 mg Zentel tablets or 10or 20 ml (400 mg) of Zentel suspension) as asingle dose.

Usual dose in children 1-2 years of age: 200 mg(one 200 mg Zentel tablet or 5 or 10 ml of Zentelsuspension) as a single dose.

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In cases of suspected or confirmedStrongyloidiasis, Taeniasis or Hymenolepis nanainfestation, Zentel 400 mg once daily should begiven for 3 consecutive days. In cases of provenHymenolepis nana infestation, retreatment in10-21 days is recommended.

If the patient is not cured on follow-up after 3weeks, a second course of treatment isindicated.

The tablets may be chewed, swallowed orcrushed and they should be taken with food.No specific procedures, such as fasting orpurging, are required.

CONTRA-INDICATIONS, WARNINGS, ETCCautionsUse in pregnancy: Because albendazole wasfound to be embryotoxic and teratogenic in therat and rabbit, its use is contra-indicated inpregnant women or those likely to be pregnant.For women of childbearing age (15-40 years),Zentel should be administered within 7 daysafter the start of normal menstruation, or after anegative pregnancy test.

Use during lactation: It is not known whetheralbendazole or its metabolites are secreted inhuman breast milk. Zentel should not, therefore,be used during lactation unless the potentialbenefits are considered to outweigh the potentialrisks associated with treatment.

Adverse reactions: A few cases of uppergastrointestinal symptoms and diarrhoea,headache and dizziness have been reported, butno definite relationship with the drug has beenshown.

FURTHER INFORMATION

In addition to its vermicidal properties,albendazole has been found to have bothovicidal and larvicidal properties in man.

Pharmaceutical precautionsSuspensions should be protected from directsunlight. They should also be shaken well beforeuse.

Zentel is a trademark.

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